What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum.

This study determines if older adults can masticate regular foods via a simple test conducted using a color-changeable chewing gum. Seventy-nine consecutive inpatients of our clinic receiving rehabilitation and general medicine were assessed for eligibility. The inclusion criterion was >65 years. Thirty patients consented to participate. The main outcome variable was the food bolus texture at the swallowing threshold for five regular foods. The main explanatory variable was the a* value of the color-changeable chewing gum after 120 s of chewing (a* represents the degree of color between red and green, and a positive a* value indicates red). The mean age ± standard deviation of the participants was 81.6 ± 8.6 years, and 40% were men. Participants being able to prepare the food with suitable texture for swallowing was positively associated with the a* values in boiled rice, ginger-fried pork loin, boiled fish-paste, and rice cracker (Crude OR 1.18, 1.15, 1.17, and 1.50; P < 0.001, = 0.026, <0.001, and <0.001, respectively). The cut-off a* values had markedly high specificities (1.0) for boiled rice and boiled fish-paste and high sensitivities (0.86-0.94) for three foods, except boiled rice. We believe that mastication evaluation using the color-changeable chewing gum is not only useful but also extremely practical, even for older adults in a wide range of settings, including an individual's home. This approach would lead to a reduction in unnecessary mechanically altered or pureed food for older adults who can eat pureed food and safely provide palatable food.

Relation between change in exercise capacity and change in blood amino acids in patients with chronic heart failure.

[Purpose] Although cardiac rehabilitation (CR) is recommended for patients with chronic heart failure (CHF), adequate exercise effect cannot be obtained in elderly patients. Administration of amino acids (AA) to CHF patients has been reported to improve exercise capacity, but the changes in AA composition in plasma before and after CR had not been reported. This study aimed to measure plasma levels of AA in CHF patients and compare with values of normal range. In addition the relationship between the change of exercise capacity and AA were examined. [Subjects and Methods] Twelve CHF patients (60% males, aged 68 ± 12 years) were studied. The correction between the rates of changes in exercise capacity parameters and in plasma AA levels was investigated. [Results] Anaerobic threshold (AT) and peak oxygen uptake (VO2) improved significantly after CR. The AA profile showed no specific pattern, and citrulline (Cit) was the amino acid showing a significant positive correlation with exercise capacity (∆Cit vs. ∆AT: r=0.602, ∆Cit vs. ∆AT-work rate (WR): r=0.681, ∆Cit vs. ∆VO2/WR: r=0.635). A tendency of positive correlation was observed between ∆Cit and ∆peak VO2 (r=0.456). [Conclusion] The AA profile showed no specific pattern, but a relationship between change in exercise capacity and Cit were found.

[The decreases in motor function in the elderly].

Decreases in motor function in the elderly differ from one individual to another. These decreases may disturb their ability to perform activities of daily living and locomotion. Because of the decrease in reserve capacity that comes with age, disuse syndrome may develop, in which the individual becomes bedridden and more susceptible to another diseases and injuries. Emergency medical care workers must have adequate understanding of the motor function of the elderly. Prevention of disuse syndrome with early rehabilitation must be a top priority.

Development and evaluation of a formula for predicting introduction of medication self-management in stroke patients in the Kaifukuki rehabilitation ward.

BACKGROUND: Medication self-management in stroke patients is important to prevent further progression of disease and incidence of side effects. The purpose of this study was to create a formula for predicting medication self-management introduction in stroke patients using functional independence measure items and patient data, including medication-related information. METHODS: This was a retrospective analysis of 104 patients (cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage) discharged from the Kaifukuki rehabilitation ward at Showa University Fujigaoka Rehabilitation Hospital from January to December 2012. Multivariate analysis was performed to develop a formula for predicting achievement of medication self-management. RESULTS: Of the 104 patients, 39 (37.5%) achieved medication self-management. In the logistic regression analysis, number of drugs, age, walk/wheelchair mobility FIM, and memory FIM were extracted as significant factors independently contributing to achievement of medication self-management (p < 0.05). The prediction formula was [4.404 - 0.229 × number of drugs at admission + 0.470 × walk/wheelchair mobility FIM at admission + 0.416 × memory FIM at admission - 0.112 × age]. CONCLUSIONS: In the future, this formula may be used as an index to predict success of medication self-management in stroke patients.

Perioperative rehabilitation approaches in those over 75 years with respiratory dysfunction from chronic obstructive pulmonary disease undergoing abdominal tumor surgery.

PURPOSE: We report two cases of perioperative rehabilitation for abdominal cancer patients aged 75 years and older with severe chronic obstructive pulmonary disease (COPD). CASE DESCRIPTION: Case 1 was a 75-year-old man with COPD and 52-year history of smoking 30 cigarettes per day. The patient was diagnosed with gastric cancer and scheduled for laparoscopic total gastrectomy. Preoperative forced expiratory volume in 1 second (FEV1) was 0.64 L. He could walk with intermittent rest. Case 2 was an 81-year-old woman with COPD, bronchial asthma and 40-year history of smoking 20 cigarettes per day. She was diagnosed with transverse colon cancer and scheduled for laparoscopic-assisted partial transverse colectomy. Preoperative FEV1 was 0.70 L. She could walk indoors with T-cane. RESULTS: All staff started performing tasks simultaneously a week before surgery. Both patients were extubated soon after surgery; they could sit and take deep breaths soon after admission to intensive care unit. They could perform stepping movements early next morning, return to the general ward in the afternoon and started gait training. Because both patients could independently perform activities of daily living, they were discharged on postoperative day 13. CONCLUSION: Comprehensive perioperative rehabilitation appears to be effective in high-risk patients with severe COPD who need surgery for abdominal cancer.

Evaluation of sit-to-stand motion using a pressure distribution measurement system--effect of differences in seat hardness on sit-to-stand motion.

PURPOSE: This study examined differences between standing from an ordinary seat and standing from a low-repulsion mat using a pressure distribution measurement system (BIG-MAT) and identified parameters to determine sit-to-stand (STS) motion difficulty. METHOD: Ten healthy male volunteers (aged 30-38 years) participated. During STS motion from an ordinary seat and from a low-repulsion urethane mat, plantar surface pressure changes of both feet and the centre of pressure (COP) trajectory were recorded for 7 s. This series of tests was performed four times in each subject. Left and right pressure changes and COP changes were evaluated. Differences in the measurements between the low-repulsion mat and the ordinary seat were compared using the paired t-test. RESULTS: COP changes were similar to those previously reported. Time from hindfoot peak to forefoot peak was significantly shorter with the ordinary chair than with the mat (p < 0.05). Percent change in forefoot pressure at forefoot peak and hindfoot peak (p < 0.01) and percent change in forefoot pressure at forefoot peak and stabilisation (p < 0.05) were significantly different. CONCLUSIONS: Time from hindfoot peak to forefoot peak and percent change in forefoot pressure at forefoot peak and hindfoot peak were the best indicators of STS motion difficulty.

Experience of rehabilitation for Guillain-Barré syndrome during and after pregnancy: a case study.

PURPOSE: Guillain-Barré syndrome (GBS) in pregnancy is very rare, and there is no detailed description of rehabilitation in the literature. We report a case of GBS involving a pregnant, 34-year-old woman. CASE DESCRIPTION: She was diagnosed with Hughes grade 5 GBS during the 20th week of gestation (GW). Almost all basic motions showed total dependence. The motor functional independence measure (motor FIM) score was 31. We developed a training programme that considered the pregnancy-associated increase in her weight. RESULTS: At the 34th GW, her transfer activity became independent and she began gait training. At the 37th GW, she delivered a healthy baby spontaneously. She nursed her baby independently using a sling. After the motor FIM improved to 84, the mother and infant were discharged together 5 weeks after delivery and home-visit rehabilitation was performed while using a baby-sitter. One month after discharge, she became able to walk alone over a short distance. Finally, her endurance improved, facilitating her return to office work 15 months after discharge. CONCLUSION: We are following the patient, providing training in the movements needed for child care and suggesting environmental improvements for the mother and infant. As a result, her recovery from disability has been promoted.

After omental flap transposition, respiratory function and exercise capacity decrease.

PURPOSE: To evaluate the effect of respiratory function and exercise capacity after omental flap transposition. METHODS: From October 2005 to December 2006, we classified mediastinitis patients treated with omental flap transposition (OT group; n = 10) and patients who underwent only cardiovascular surgery without developing complications (control group; n = 25). Percent vital capacity (%VC) was evaluated from the day of returning to the general ward for 5 consecutive days and on 14 days. The day of a 200 m walk was investigated, and the cardiopulmonary exercise test was conducted after discharge. Load and oxygen consumption (VO) at anaerobic threshold (i.e., AT load and AT VO), peak load, and peak VO were measured. RESULTS: %VC significantly decreased in the OT group compared with the control group (P <0.05). An interaction effect between the 2 groups on the change in %VC was observed (F = 2.71, P <0.05). Three patients failed to accomplish a 200 m walk in the ward after omental flap transposition. AT VO and peak VO were significantly lower (P <0.05 and P <0.01, respectively) in the OT group than in the control group. CONCLUSION: After omental flap transposition, %VC and VO decreased.